Gastro: Primary Sclerosing Cholangitis: Free MSRA Podcast

⚕️FREE MSRA PODCAST –Primary Sclerosing Cholangitis🎧 A clear, high-yield walkthrough of PSC, covering everything from pathophysiology and investigations tocomplications and screening – aligned with UK NICE guidance. 🧠Key Learning Points📌Definition• PSC is a chronic, progressive liver diseasecharacterised by inflammation and fibrosis ofthe bile ducts, leading to strictures,cholestasis, and liver damage. 📌Causes & RiskFactors• Exact cause unknown, but likely due to geneticand immune factors.• Strongly associated with Ulcerative Colitis(80% of PSC patients have UC).• Typically affects men aged 30–60.• Otherassociations: Crohn’s disease, HIV (rare). 📌Mnemonic for RiskProfile🧍‍♂️ + 🧻 = PSC(Young man +Ulcerative Colitis = Think PSC) 📌Pathophysiology• Immune-mediated damage leads to chronicinflammation and fibrosis of bile ducts(intrahepatic and extrahepatic).• Results in strictures, obstructed bile flow, andeventually cirrhosis or liver failure.• Characteristic “beaded appearance” on imaging (MRCP). 📌DifferentialDiagnosis – VITAMIN B• Vascular: Portal vein thrombosis• Infective: Recurrent cholangitis, AIDS-related• Trauma: Post-surgical bile duct injury• Autoimmune: IgG4-related cholangitis,autoimmune hepatitis• Malignancy: Cholangiocarcinoma• Iatrogenic: Post-ERCP, TPN• Benign: Gallstones 📌Epidemiology• Rare, ~8–15 per100,000 in the UK• 10% of liver transplants in the UK are due toPSC• Median lifeexpectancy post-diagnosis ≈ 12 years• Risk of cholangiocarcinoma and colorectal cancer (especially with UC) 📌Clinical Features• Often asymptomatic early• Symptoms: Fatigue, pruritus,jaundice, rightupper quadrant pain, weight loss• Recurrent episodesof cholangitis (fever, pain, jaundice)• Signs: Scratch marks, hepatomegaly,excoriations, signs of cirrhosis 📌Diagnosis• Bloods: Raised ALP,GGT, sometimes bilirubin• Autoantibodies: p-ANCA may be positive (notspecific)• MRCP: Gold standard – shows beaded ducts• ERCP: Diagnostic + therapeutic• Liver biopsy: For staging or diagnosingsmall-duct PSC 📌Management• No cure, treatment is symptomatic andpreventative• Pruritus: Cholestyramine (1st line),rifampicin, naltrexone, SSRIs• Nutrition: Supplement fat-soluble vitamins (A,D, E, K)• Avoid alcohol, regular bone health monitoring• ERCP for dominant strictures• Liver transplant: Only definitive treatment foradvanced disease• No routine use of UDCA – not proven to improveoutcomes 📌Complications• Bile duct obstruction• Recurrent cholangitis• Liver cirrhosis and failure• Cholangiocarcinoma• Colorectal cancer (especially with UC)• Hepatic osteodystrophy 📌Emergency – SuspectCholangitis• Charcot’s triad: Fever + RUQ pain + Jaundice• Treat urgentlywith IV antibiotics and ERCP drainage 📌Screening• Annual colonoscopy if PSC + UC• Gallbladder ultrasound to screen for polyps orcancer• Monitor LFTs, bone health, and symptomsregularly 📎More MSRA Resourcesfor Primary Sclerosing Cholangitis📝 Revision Notes:https://www.passthemsra.com/topic/primary-sclerosing-cholangitis-revision-notes/🧠 Flashcards:https://www.passthemsra.com/topic/primary-sclerosing-cholangitis-flashcards/💬 Accordion Q&A Notes:https://www.passthemsra.com/topic/primary-sclerosing-cholangitis-accordion-qa-notes/🚀 Rapid Quiz:https://www.passthemsra.com/topic/primary-sclerosing-cholangitis-rapid-quiz/🎓 Full Course:https://www.passthemsra.com/courses/gastroenterology-for-the-msra/ Hashtags#MSRA#MSRARevisionNotes #MSRAFlashcards #MSRAAccordions #MSRAQuestionBank #MSRAQuiz#PrimarySclerosingCholangitis #GastroenterologyMSRA #Cholangiocarcinoma#MRCPImaging #MSRAOnlineRevision